Entering the hospital to start my workday is different now.
Instead of cutting through the closest back entrance to my department's workroom, I join a line of employees walking through the same closely monitored entrance. Like all other employees entering the building, I am asked a series of questions: "Do you have any fevers or chills? Any cough? Shortness of breath?" A forehead thermometer takes my temperature.
If I pass this screening, I'm given a mask and directed to get a few pumps of hand sanitizer. Then, finally, I'm on my way to my workroom to really start my day.
For the friends and family members of my patients, however, entering the hospital doesn't mean enduring inconveniences. For them, it's not an option at all.
Limiting visitors to flatten the curve
Hospital visitor precautions are attempting to minimize potential exposure and further community spread of COVID-19. While healthcare workers have been deemed essential components of a hospital's operations, visitors have not. The timing of this decision has varied from hospital to hospital, but similar visitor precautions are now in place throughout most major medical systems as well as most skilled nursing or long-term care facilities.
Each hospital may have its own exceptions to the policy. For example, a pediatric patient is allowed to have a parent with them at my hospital. This is an essential exception to the policy for both the emotional well-being of the child and for potential legal issues, as any medical consents must typically go through someone over 18.
While a no-visitor policy is essential for "flattening the curve" to curb the spread of the highly contagious COVID-19 virus, a lack of in-person family or friend support for a hospitalized patient can make an already stressful situation even more so.
It means not being able to be there for a loved one who has just had a heart attack and is in the cardiovascular intensive care unit. It means not being able to hold the spouse who has just been told that they have stage IV cancer when they thought they were just going to the ER for a bad headache. For some, it means not being able to be at the bedside of a loved one when they die, or not being able to encourage their spouse as they give birth to a highly anticipated baby. While some hospitals have allowed for an exception in policy and permitted one visitor at the bedside of a woman giving birth, others have not. Giving birth for the first time is stressful for anyone, and this situation makes it even more anxiety-inducing.
The impact on physicians
For a physician, keeping family updated on the progress of a patient is usually much easier in person than over the phone. I used to only make a few phone calls a day to family members, but now, I always have a full list of spouses and parents who would like calls regarding their loved ones' condition. These updates would be unnecessary if they were able to see their loved ones in the hospital.
Visitor restrictions also impact our ability to provide family members with vital information for their loved one's successful transition to home. Teaching a family member how to safely help a new spinal cord patient to transfer from a wheelchair to a car is difficult to do unless you've practiced it in person. Informational handouts and video calls via FaceTime or other similar programs are helpful, but they can't provide families with the hands-on experience that a patient needs.
Possibly one of the hardest struggles I've had a physician recently was calling a family member and telling them that their loved one was experiencing rapidly declining respiratory status, that their imaging was concerning for ARDS and that they needed to be transferred to the ICU and likely intubated very soon. While a medical provider knows there are numerous reasons for such a presentation beyond COVID-19, a nonmedical family member doesn't have the comfort of this knowledge. They only have the news reports where they see the number of deaths from COVID-19 increasing every day, and they can't help but wonder if this is why their loved one is ill.
COVID-19 is an unprecedented challenge that our world is uniting to face, but it's a challenge that affects more people than those who test positive for the virus. It impacts anyone within the hospital system who sees only masks instead of the faces of their medical providers and who feels only gloves instead of another human hand. Acknowledging the challenges that non-COVID patients and families are struggling with because of this pandemic is an essential part of patient-centered care right now.